References To Anesthesia, Pain, And Analgesia In The .
General ArticlesSpecial ArticleReferences to Anesthesia, Pain, and Analgesia in theHippocratic CollectionElisabeth Astyrakaki, MD*Alexandra Papaioannou, MD,PhD, EDA*†Helen Askitopoulou, MD, PhD,DA, FRCA*†The Hippocratic Collection, containing 60 medical texts by Hippocrates and hispupils, was searched using the electronic database Thesaurus Lingua Graeca toidentify the words “anaesthesia” and “analgesia,” their derivatives and also wordsrelated to pain. Our purpose was to investigate the special use and meaning ofthese words and their significance in medical terms. The word “anaesthesia”appears 12 times in five Hippocratic texts to describe loss of sensation by a diseaseprocess. This observation reveals Hippocrates as the first Greek writer to use theword in a medical rather than a philosophical context. Hippocrates was also thefirst Greek physician to keep an airway open by bypassing a pharyngeal obstruction with the insertion of narrow tubes into the swollen throat of a patient withquinsy, thus facilitating the airflow into the lungs. In the Hippocratic texts,“analgesia” is related to “anaesthesia” for the first time, when it is pointed out thatan unconscious patient is insensitive to pain. Hippocrates and his followersrationalized pain as a clinical variable and as a valuable diagnostic and prognostictool. They used expressive and precise adjectives and well-defined characteristicsof pain, such as location, duration, or relation to other symptoms, to elucidate adisease process. They also had a wide terminology for the various types of pain,still in use today. Many cures were described for the treatment of pain, includingincisions, effusions, venesection, purges, cauterization and, most interestingly, theuse of many plants, such as opium or the application of soporific substances. Inparticular, Hippocrates refers to opium poppy as “sleep inducing.”(Anesth Analg 2010;110:188 –94)It is widely believed that the Greek philosopherDioskourides was the first to use the word “anaesthesia”*in the 1st century CE to describe the narcotic effects ofthe plant mandragoras (mandrake).1 However, theword had been used by Greek scholars as a philosophical concept almost 5 centuries before it was used todescribe a pharmacologic action.1,2 The historianThucydides (460 – 400 BCE) described the word“anaesthesia” as “bluntness of perception”† to denotepolitical indifference and disinterest,3 whereas inPhilebus by Plato (427–348 BCE), the word has thephilosophical meaning of “the oblivion of the soul fromFrom the *Department of Anesthesiology, University Hospital ofHeraklion; and †Department of Anesthesiology, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.Accepted for publication April 13, 2009.Reprints will not be available from the author.Address correspondence to Helen Askitopoulou, MD, PhD, DA,FRCA, 31 Stefanou Nikolaidi St., Heraklion, Crete GR 71 305,Greece. Address e-mail to askitop@her.forthnet.gr.*Ancient Greek words using Latin characters are given inregular characters and inverted commas “. . .”†English translations of original Greek texts are given in italiccharacters and inverted commas “. . .”Copyright 2009 International Anesthesia Research SocietyDOI: 10.1213/ane.0b013e3181b188c2188the movements of the body” or “want of perception.”2,4 It isin the writings of Hippocrates (c. 460 –380 BCE) thatwe find the word “anaesthesia” used for the first timein a medical context as loss of sensation and unconsciousness. The Hippocratic Collection, containing 60articles, represented a canon for those studying medicine. Although not all were written by Hippocrateshimself, and they are believed to be part of a librarybased at the School of Kos, they reflect medical conceptsand practices for at least 4 centuries BCE, some of themstill accepted by contemporary medicine.The purpose of this study was to investigate thespecial use and meaning of ancient Greek words relatedto anesthesia, pain, and analgesia in the HippocraticCollection and to relate some of them to modern Greekterms. It is the study of texts in their original languagethat helps us to improve our understanding of medicineand anesthesia in the 21st century.METHODSThe words related to anesthesia, analgesia, andpain and their derivatives were searched in all 60Hippocratic articles using the Thesaurus LinguaGraeca electronic program.5 This program is an electronic database of the entire ancient Greek literature,Vol. 110, No. 1, January 2010
Table 1. The Word “Anaesthesia” and Its Derivatives, Their Explanation in English and the Citations in the Hippocratic CollectionWhere These Words AppearaDerivatives of the word“anaesthesia”Explanation in EnglishCitation“Anaesthesia” 关 ι 兴 (2)Noun, meaning: loss of sensation, unconsciousness“Anaesthetos” 关 ι 兴 (5)Adjective, meaning: senseless“Anaesthetos” 关 兴 (3)Adverb, derived from the adjective “anaesthetos”关 ι 兴Noun, dative in plural, derived from the adjective“anaesthetos” 关 ι 兴, in ionic formNeuter comparative adjective of“anaesthetos”关 ι 兴, meaning: less sensitive“Anaesthetoisi” 关 兴 (1)“Anaesthetotera” 关 o 兴 (1)aCoan Prenotions, 466.1Letters, 10th Letter, line 43Breaths, 13.3 & 14.44Epidemics, 7.1.1.21Coan Prenotions, 395.3Use of Liquids, 1.27–33Epidemics, 3.3.17.12 & 3.3.17.15Coan Prenotions, 621.8Letters, 17th Letter, line 291Ancient Medicine, 15.25In brackets 关. . .兴 is given the original Greek spelling in the monotonic system, and in brackets (. . .) the total number of times each word appears.itemizing the works of all classic authors. The database includes search options for a combined search.For example, a particular word can be sought in aparticular work, author, or in all classic literature, andthe program automatically provides the number ofcitations together with the relevant text. Specifically,the words “anaesthesia” [ ι ],‡ “analgesia”[ ι ], and the ancient Greek words Hippocrates used most frequently for pain, such as “algos” [ ], “algema” [ ], “odyne” [ ],and “ponos” [ ó ] were sought in all 60 Hippocraticarticle. In the word search mode, there are optionssuch as “exact word,” “prefix,” “suffix,” and “any.”We used the “any” mode and entered only the prefixof the words to be searched, to find citations that alsoinclude words with common roots, compound words,or words stemming from the particular words. Forexample, we entered the prefix [ ] for“anaesthesia” related words, and [ ], [ ],[ ], and [ ó ] for the words “algos,” “analgesia,”“odyne,” and “ponos,” respectively. The relevantcitations were then examined in the original Greektexts and compared with classic English translations.RESULTSThe word “anaesthesia” and its derivatives appearonly 12 times in five Hippocratic texts (Table 1). “Algos,”the ancient word for pain, is also mentioned only 14times, in contrast to words stemming from it that arevery common, appearing 483 times (Table 2). Suchwords are the verb “algeo” and its derivatives andthe very common adjective, still in use, “algeinos,” andcompound medical terms such as “kardialgia,”6a“hysteralgia,”7a “cephalalgia,”8a and “osphyalgia”9a(Table 3). The contemporary term “analgesia” derivedfrom the words “algos” and “algeo” and the privativeprefix “an” does not appear as such in the HippocraticCollection. Its derivatives, the adjectives “analgetos”10a,11a‡Ancient words using Greek characters and in the monotonicsystem are given in brackets [. . .].Vol. 110, No. 1, January 2010and “analgea”12 appear four times. In contrast to“algos,” a common word for pain in the Hippocratictexts is “odyne” (pain of body and pain of mind),13appearing almost 884 times as such or as a compoundword such as the adjectives “epodynos”6b and“anodynos.”11b “Ponos” is also a very common medical term, appearing about 722 times (Table 2).DISCUSSIONUse of the Word “Anaesthesia” and Its Derivativesby HippocratesThe search of the articles of the entire HippocraticCollection revealed that the word “anaesthesia” wasfirst used in a medical context, as loss of consciousnessand sensation, by Hippocrates (c. 460 –380 BCE). In thework Breaths, the word “anaesthetos” (senseless) acquires the medical meaning of loss of sensation, whenHippocrates writes: “For when they [breaths] passthrough the flesh and puff it up, the parts of body affectedlose the power of feeling [“anaestheta”§]”10b (Table 1). Itis from the Greek adjective “anaesthetos,” still in usetoday, that the word “anaesthesia” was derived, in thesame way as “analgesia” was derived from the adjective “analgetos” (not sensing pain).2 In the same work,“anaesthesia” is related to “analgesia” for the firsttime, when it is stated that an unconscious patient isalso insensitive to pain: “At this time the patients areunconscious [“anaesthetoi”§] of everything, deaf to whatis spoken, blind to what is happening and insensible to pain[“analgetoi”§].”10a However, both words express lossof feeling and pain insensitivity caused by a diseaseprocess rather than from a pharmacologic action.Another example described in the work Epidemics isthe case of a patient who “took no notice [“anaesthetos”]” of his symptoms on the seventeenth day of hisfatal disease.14a Again, the loss of consciousness isrelated to a fatal outcome. It is remarkable howHippocrates recognizes the consequences of a serious§The endings “a,” “oi,” and “ai” indicate plural forms. 2009 International Anesthesia Research Society189
Table 2. The Most Frequently Used Words for Pain and Their Derivatives, Their Explanation in English and the Main Works of theHippocratic Collection Where These Words AppearaWords relatedto pain“Algos 关 兴 (14)Their derivativesNoun “algema” 关 兴 (194)Noun “algedon” 关 兴 (13)Adjective “algeinos” 关 o 兴 (2)Verb “algeo” 关 兴 (185)“Odyne” 关 兴(772)“Ponos” 关 o 兴(498)aPast participle of the verb algeo“algesas” 关 兴 (4)“Proalgesas” 关 兴, past tenseparticiple of the verb “proalgeo,”derived from the preposition “pro”and the verb “algeo” (4)Noun “analgesia” 关 ι 兴 derivedfrom the words “algos” and “algeo”and the privative prefix “an”Adjective “analgetos” 关 兴,derived from the privative “an” and“algos” (3)Adjective “analgea” 关 兴, derivedfrom the privative “an” and “algos” (1)Verb “odynao” 关 兴 (51)Noun “odynema” 关 兴 (5)Adjective “odyneros” 关 o 兴 (2)Adjective “odynodes” 关 兴 (54)Adjective “epodynos” 关 兴 ,derived from the preposition “epi”and odyne (53)Adjective “anodynos” 关 兴,derived from the privative “an” andodyne (50)Verb “poneo” 关 兴 (224)Explanation in EnglishPain felt or caused, sufferingPain, suffering of body ormind, griefPainful, grievousTo feel bodily pain, to suffer,to feel pain of mindSmarting with painMain Hippocratic worksin which these wordsappearEpidemics (81)Coan Prenotions (88)Prorrheticon (38)Feel pain beforehandAbsence of sense of painFree of painPainlessCause one pain or sufferingPainPainful, distressingPainfulPainfulEpidemics (180); Diseases I–III(141); Diseases of women (116);Internal affections (69)PainlessWork hard, suffer, toil inpraying, toil in fight, to bebusy with, suffer fromillness, be sick, work hardat, make or do with painsor care, afflict, distressEpidemics (112); Aphorisms(28); Coan Prenotions (84)In brackets 关. . .兴 is given the original Greek spelling in the monotonic system, and in brackets (. . .) the total number of times each word appears.Table 3. Compound Medical Terms of the Word “algos” in the Hippocratic CollectionaCompound wordsfrom the word “algos”and the verb “algeo”“Gonyalgia”关 ι 兴 (2)“Dialges” 关 兴 (1)“Kardialgia”关 ι 兴 (23)“Cephalalgia”关 ι 兴 (63)“Osphyalgia”关 ι 兴 (6)“Hysteralgia”关 ι 兴 (1)Derived from“Gony” 关 o 兴b and theverb “algeo” 关 兴The preposition “dia” 关 兴and “algos” 关 兴“Kardia” 关 ι 兴b heartand the verb “algeo”关 兴“Cefale” 关 兴b and theverb “algeo” 关 兴“Osphys” 关 兴b and theverb “algeo” 关 兴“Hystera” 关 兴b and theverb “algeo” 关 兴Explanationin EnglishMain Hippocratic works inwhich these compoundwords appearPain in the kneeEpidemics (2)GrievousDiseases I–III (1)Suffering fromheartburnEpidemics (11); Coan Prenotions (8);Prorrheticon (3)HeadacheCoan Prenotions (31); Prorrheticon(16); Epidemics (7)Coan Prenotions (5); Prorrheticon (1)Lumbago, backpainPain in thewombRegimen in Acute diseases (1)aIn inverted commas “. . .” are given the original Greek words in Latin characters, in brackets 关. . .兴 the same words in Greek characters in the monotonic system, and in brackets (. . .) the totalnumber of times each word appears.bExplanation in English of the prefix words used: “gony” knee; “kardia” heart; “cefale” head; “osphys” 关 兴 back; “hystera” 关 兴 womb.190Anesthesia, Pain, and Analgesia in HippocratesANESTHESIA & ANALGESIA
illness with a fatal outcome. In Coan Prenotions, apatient with inflammation of the lungs and heart isparalyzed [“paraluetai”] completely, lies frozen, andsenseless [“anaesthetos”] and eventually dies on thesecond or third day.9b In the same work, he remarksthat any evacuation which takes place without thepatient sensing it [“anaesthetos”] is fatal.9cAnother interesting clinical observation of anuntoward effect that leads to a coherent and practical suggestion is found in the work Use of Liquids.Hippocrates describes the use of warm water as acure and suggests that the water should not behotter than the patients can tolerate, “except in casesof loss of speech, paralysis, numbness [“nenarkomenoisin”] or anesthesia [“anaestheta”],” otherwise thedoctor may cause burns without realizing it.15 Inthese lines, we find the Greek word “nenarkomenoisin” which is a passive perfect participle of the verb“narkoo” (to grow numb), from which “narcosis” isderived, next to the word “anaestheta.” In one of hisbest-known works, Ancient Medicine, Hippocratesattributes to inanimate objects, like “a leathern orwooden vessel” the human properties of being “lesssensitive [“anaesthetotera”] than man . . .” to the effect of “hot or cold and astringent or insipid”things.16Components of Contemporary “Anaesthesia” in theHippocratic CollectionAlthough Hippocrates does not refer to pharmacologic anesthesia and its different aspects, he knowsthat some substances can induce sleep. Most interestingly, in Epidemics the word “hypnikon” (producingsleep) is found, derived from the word “hypnos”(sleep), from which the contemporary word hypnosisoriginates.13 Hippocratic doctors used the word“hypnikon” to describe soporific substances appliedto patients with toothache.6c A related word “hypnoticon,” still used in modern Greek, from which the termhypnotic is derived, is found in the work Diseases ofWomen in which Hippocrates refers to “meconium”(opium poppy) as “sleep producing” [“hypnotikon”].17Hippocrates in his writings also refers to somefundamental components of contemporary anesthesia,such as airway protection, the state of sleep and theterm “narcosis.” In one of his best-known works,Diseases III, he describes the insertion of narrow tubesinto the swollen throat of a patient suffering from“kynanche,” the Greek word for quinsy. “With angina[“kynanche”], as it is called, the person chokes and seemsto have something like an apple caught in his throat.” As atreatment, the author suggests that the doctor “mustalso clean out the lower cavity with medication or enema,and insert tubes [“avliskoi”] into the throat behind thejaws, in order that air may be drawn into the lung.”18a Wemay assume that these tubes that kept an open airwaymust have been premature types of a nasopharyngealairway or even a tracheal tube. In this case, Hippocrates might be the first ancient Greek physician toVol. 110, No. 1, January 2010manage the airway by bypassing a pharyngeal obstruction and facilitating the airflow into the lungs.In the Hippocratic work Coan Prenotions, the word“narke” (temporary decline or loss of senses andmovement), from which the word “narcosis” (state ofunconsciousness or drowsiness produced by a drug)was later derived, is used jointly with the word“anaesthesia.” In this work, Hippocrates states thatwhen unaccustomed numbness and loss of sensibility,“narkai . . . and anesthesiai,” are present in a patientsuffering from strangulating ileus, this is a warningsign of “apoplexy.”2,9d In Aphorisms, “narke” is alsoused to describe physical “numbness” and also “dullness of intelligence.”19a,bThe philosophical issue of sleep was exploredextensively by ancient Greek scholars including Aristotle. Hippocrates approached the issue from thephysiologist’s perspective. He had noticed that duringsleep the body cannot perceive external stimuli, and itis the soul, the contemporary subconscious state,which not only keeps its functions but also even takesover those of the body. In the work Dreams, he clearlydifferentiates the state of sleep from the waking state:“The body when asleep has no perception; but the soul whenawake has cognizance of all things, sees what is visible,hears what audible, walks, touches, feels pain, ponders. In aword, all the functions of the body and of soul are performedby the soul during sleep.”20 However, he only refers tonatural sleep and not pharmacologic sleep. This can beexplained by his opposition to surgery, which he leftto other practitioners. The Hippocratic Oath unambiguously states: “I will not use the knife, not even, verily,on sufferers from stone, but I will give place to such as becraftsmen therein.”21 This interdiction against the knifeexplains why in the Hippocratic Collection there is nota single reference to the use of soporific plants oropium to calm the acute pain of surgery. However,Hippocrates must have known the properties of thosesubstances and often used them for the treatment ofpain, as we will see later.Even though Hippocrates did not describe anesthesiawith the word “anaesthesia” as it is defined today, hewas the first to use this word in a medical context todescribe loss of consciousness and sensation. Five centuries later, Dioskourides used this word to describe theabsence of sensation caused by drugs.1 Finally, morethan 2000 years after Hippocrates, Oliver WendellHolmes in a moment of inspiration, very accurately,used this word to describe a state closer to the moderndefinition and understanding of clinical anesthesia.The Vocabulary of Pain in the Hippocratic CollectionHippocratic physicians developed a rich vocabulary for pain in which the physical and moral elementsoverlap. There are numerous citations throughout theHippocratic Collection describing and differentiatingbetween painful conditions. The words and theirderivatives most frequently used by Hippocrates are“algos,” “algema,” “odyne,” and “ponos” (Table 2). 2009 International Anesthesia Research Society191
Table 4. Adjectives Describing the Different Types of Pain in the Hippocratic Collection and Their Explanation in EnglishaAdjectives for pain“Deine” 关 兴 “odyne”“Ischyri” 关 兴 “odyne”Explanation in English“Karebarike” 关 兴 “odyne”Fearful, terrible painPowerful, forcible, violent,severe painPain causing heavy head“Oxeia” 关 ι 兴 “odyne”Acute, sharp pain“Sphodros” 关 o 兴 “ponos”Vehement, violent, excessive,severe painCold pain, in the sense of oldand chronicWarm pain, in the sense ofrecent“Psychrai” 关 ι 兴 “odynae”“Thermai” 关 ι 兴 “odynae”aMain Hippocratic works in which theseadjectives for pain appearEpidemics (book 7, section 5)Epidemics (book 2, section 5, paragraph 2); InternalAffections (section 14)Epidemics (book 3, chapter 3, case XII); Coan Prenotions(section 164)Coan Prenotions (section 514); Internal Affections(section 28)Regimen in Acute Diseases (Appendix, section 55)Epidemics (book 6, section 1, paragraph 7)Epidemics (book 6, section 1, paragraph 7)In brackets “. . .” are given the original Greek words in Latin characters, in 关. . .兴 the same words in Greek spelling in the monotonic system and in (. . .) a specific citation for each work.Some of them, still in use in modern Greek, are alsofound as loans in compound words in other languages. In the Hippocratic Collection, “algos” represents a more general type of suffering involving thewhole body, which is prolonged and susceptible torecurrence.22 The word “algema,” like “algos,” is usedfor a more general type of pain, such as “chronic pain inthe loins,” “pains of the forearms and the neck,” or even todifferentiate between types of headache.8b– d “Odyne”describes acute, sharp, and localized pain and intensemental pain.2,22 In Epidemics “odyne” is used to explain “pain in the left ribs”6d or “pain in the righthypochondrium.”14b The compound word “epodynos”(painful) is used to describe painful areas of the bodylike a “painful sprain behind the thumb.”6b “Ponos,” themodern Greek word for pain, originally meant laborand hard work in the Homeric epics. This meaningmay have originated from the personification of “Ponos” (Toil) and “Algea” (Sorrows) as children of thehard-hearted goddess “Eris” (Strife) in Greek mythology.23 Much later, the consequences of labor or distress were described as “ponos” in which case it meantphysical pain.24 However, it was Hippocrates whoused the word to describe the physical pain caused bydisease, such as pain in the joints.19c “Ponos,” like“algos” describes a more general type of pain (Table1), for example, “heaviness in the bowels with pain,”“painful, continuous, acute fever,” or “chronic and painful,watery inflammations of the eyes.”14cThe Significance of Pain as a Diagnostic andPrognostic ToolHippocrates was the first physician to rationalizepain and use it as a valuable diagnostic and prognostictool. He considered pain in relation to the overallclinical picture of the patient and not as an isolatedsymptom. He used the clinical features of pain asimportant manifestations in the disease process and asa major tool to outline the prognosis and severity of anillness. Numerous citations throughout the Hippocratic texts testify to this. For example, Hippocratesnoted the time when the pain starts, to elucidate the192Anesthesia, Pain, and Analgesia in Hippocratescourse of the pathogenic process: “. . . pains and feversoccur when pus is forming rather than when it has beenformed”19d or, in the case of consumption in theEpidemics, “in the majority of these cases the throat waspainful throughout from the beginning”14d When twodifferent, distinct pains occurred simultaneously, herelated the most intense one to the more seriousillness: “when two pains occur together, but not in thesame place, the more violent obscures the other.”19e Theanatomical location of the pain was an importantdiagnostic sign. In Prognostics, for example, pain accompanied by tachypnea indicated ailments in thechest: “rapid respiration indicates pain or inflammation inthe parts above the diaphragm.”25a Also, in Aphorisms it ispointed out that “pains and swellings of the belly are lessserious when superficial, more severe when deep –seated.”19f Specific features of pain, such as duration,intensity, location, or depth, were sought and scrutinized to determine the fatality or seriousness of adisease: “Violent and continuous headaches, should therebe in addition one of the deadly signs, is a very fatalsymptom . . .”25b or “pains occurring with fever in theregion of the loins and lower parts, if they leave the lowerparts and attack the diaphragm, are very mortal.”25cTo explain, emphasize or differentiate among thedifferent manifestations of pain, Hippocrates complements these terms with precise adjectives, such as“oxeia odyne,”25d or “ischyros ponos”14e (Table 4).Nonpharmacologic and Pharmacologic Cures for PainfulConditions in the Hippocratic TextsIn the Hippocratic Collection, many different nonpharmacologic cures for painful conditions are described, such as diet, heat, cold, ablution, purging,cauterization, expectoration, venesection, incisions forpleurisies, or hot effusions for headaches. Some ofthem are quite bizarre by modern medical standards.For example, in the Aphorisms, the opening of a vein,“phlebotomy” (venesection), was suggested for curingheadaches: “Pains at the back of the head are relieved byopening the upright vein in the forehead.”19g Again, in apatient with delirium and “aphonia” (loss of voice)ANESTHESIA & ANALGESIA
who suffered from pains in the heart, “phlebotomystopped these pains.”6e For gastrointestinal pains, acommon treatment was purging. “Pains above thediaphragm indicate a need for upward purging; pains belowindicate a need for downward purging.”19h Rest plays amajor role in the relief of pain: “In every movement of thebody, to rest at once when pain begins relieves thesuffering.”19iIn certain sections of the Hippocratic work greatemphasis is placed on therapies in which oppositescure opposites and like curing like. In Places in Man, itis explained that “pains are cured by opposites.” In thesame passage it is stated that, “sometimes conditions canbe treated by things opposite to those from which they arose,and sometimes by things like to those from which theyarose.”26a It is worth wondering whether these observations were the forerunner of later discoveries aboutactivation or deactivation of facilitating or inhibitingmechanisms during nociception.In addition to nonpharmacologic cures, Hippocraticphysicians also used the different properties of various substances. In Places in Man, it is clearly stated that“all substances that change the state of a patient aremedications [‘pharmaka’].”26b In the Hippocratic Collection, 236 distinct plants are mentioned. Most ofthem have soporific, narcotic, or poisonous properties,such as mandrake, henbane (Hyoscyamus), nightshade,and especially poppy.27 In the work Fistulas, it issuggested that a patient with anal inflammation andprotrusion should “drink white meconium” (whitepoppy) if the pain does not subside by other means.28In Diseases III, for pain in the hypochondrium due topleurisy, it is suggested to give the patient whiteopium poppy to drink with other substances, such as“cumin, flower of copper, honey, vinegar, water” andothers.18b The opium extracts in the Hippocratic textswere mainly prescribed for painful gynecological ailments.29,30 Other substances used for the same painfulconditions include silphium (a sort of asafetida),30cumin with honey, leek,30 cyclamen,30 and manyothers. In Regimen in Acute Diseases, the author suggests the use of black hellebore (Helleborus niger) andpeplium (Euphorbia peplus or petty spurge) as purgatives that stop the pain, in combination with daucus(Athamanta cretensis), seseli (Laserpitium latifolium orlaserwort), anise, and juice of silphium.7bCONCLUSIONSThe study of the Hippocratic Collection in theoriginal Greek language revealed Hippocrates as thefirst physician to use the words “anaesthesia” and“analgesia” in a medical context. His realistic approach to health and healing led to important observations on fundamental components of contemporaryanesthesia, such as the state of sleep and narcosis andalso sleep-inducing substances. In the Hippocratictexts, analgesia is related to anesthesia for the firsttime, when it is pointed out that an unconsciousVol. 110, No. 1, January 2010patient is insensitive to pain. Hippocrates may havebeen the first physician to keep an open airway andfacilitate airflow to the lungs by bypassing an inflammatory obstruction of a patient’s throat with theinsertion of a premature type of oropharyngeal airwayor, probably, tracheal tube.Hippocrates and his followers rationalized painand defined its various characteristics, such as location, duration, and relation to other symptoms. Toelucidate a disease process, they developed a widepain vocabulary, still in use today. Pain was developed as a diagnostic and prognostic tool to helpdifferentiate between various painful conditions. According to the Hippocratic writings, the therapeuticapproach to painful conditions included diverse,sometimes bizarre, nonpharmacologic, and pharmacologic cures. The opium poppy was one of them, but itwas also used as a “sleep-inducing” substance.The rational clinical observations of Hippocratesfreed medicine from religion and laid the ground forthe development of medicine as a systematic science.The wealth of medical knowledge found in the Hippocratic writings explains why he is considered thefather of modern medicine.REFERENCES1. Morch ET, Major RH. Anaesthesia. Early use of the word.Anesth Analg Cur Res 1954;33:64 – 82. Askitopoulou H, Ramoutsaki IA, Konsolaki E. Analgesia andanesthesia: etymology and literary history of related Greekwords. Anesth Analg 2000;91:486 –913. Thucydides. The Peloponnesian War. Riiys E, ed. Crawley R,transl. London: Dent JM. New York: Dutton EP, 1933: book I,chapter III, section 694. Plato. Philebus. In: Statesman. Philebus. Ion. Vol VIII. Goold GP,ed. Fowler HN, transl. Cambridge, MA: Harvard UniversityPress, 1975: Stephanus page 34, section a5. Musaios [computer program]. Version 1.0e, 32. Los Angeles:Thesaurus Lingua Graeca, 19926. Hippocrates. Epidemics 2 & 4 –7. In: Hippocrates Vol VII:Epidemics 2 & 4 –7. Smith WD, ed. and transl. Cambridge, MA:Harvard University Press, 1994; (a) Epidemics 4, section 16, line3; (b) Epidemics 5, section 75, lines 2–3; (c) Epidemics 6, section6, section 13; (d) Epidemics 2, section 3, section 3, lines 3– 4; (e)Epidemics 5, section 8, lines 4 –57. Hippocrates. Regimen in acute diseases. In: Goold GP, ed. JonesWHS, transl. Hippocrates vol II: prognostic. Regimen in acutediseases. The sacred disease. The art. Breaths. Law. Decorum.Dentition. Cambridge, MA: Harvard University Press, 1998; (a)section LXI; (b) section XXIII8. Hippocrates. Prorrhetic 1–2. In: Fistulas. Potter P, ed. and transl.Hippocrates vol VIII: Places in man. Glands. Fleshes. Prorrhetic1–2. Ph
to anesthesia, pain, and analgesia in the Hippocratic Collection and to relate some of them to modern Greek terms. It is the study of texts in their original language that helps us to improve our understanding of medicine and anesthesia in the 21st century. METHODS The wor
pain”, “more pain” and “the most pain possible”. Slightly older children can also say how much they are hurting by rating their pain on a 0-10 (or 0-100) scale. Zero is no pain and 10 (or 100) is the worst possible pain. What a child is doing Often children show their pain by crying, making a “pain” face, or by holding or rubbing .
Short-term pain, such as when you suffer a sprained ankle, is called 'acute' pain. Long-term pain, such as back pain that persists for months or years, is called 'chronic' pain. Pain that comes and goes, like a headache, is called 'recurrent' pain. It is not unusual to have more than one sort of pain or to have pain in several places
General discussions of pain often refer simply to three types: 1) Acute (brief that subsides as healing takes place) 2) Cancer 3) Chronic non-malignant pain - "persistent pain" Classification of pain by inferred pathology: 1) Nociceptive Pain 2) Neuropathic Pain (McCaffery & Pasero, 1999) Nociceptive Pain A. Somatic Pain B. Visceral Pain
Knee Pain 1 Knee Pain 2 Knee Pain 3 Knee Pain 4 Knee Pain 5 Lateral Knee Pain Medial Knee Pain Patella Pain 1 Patella Pain 2 Shin Splint. 7 Section 6 Ankle/Foot Big Toe 89 . For additional support, wrap another tape around the last finger joint. Step 3. No stretch is applied during application. 30 Step 1 Step 2 Finger Pain. 31 Requires;
The shortage of qualified anesthesia providers and the increased demand for anesthesia services create a highly competitive marketplace. Weigh the compensation of the current anesthesia team against the local market rate. ANESTHESIA SUBSIDY Hospitals provide additional financial support in the form of anesthesia subsidies to
anesthesia services as well as anesthesia services that are an integral part of procedural or pain management services. Reimbursement Guidelines Anesthesia services must be submitted with a CPT anesthesia code in the range 00100-01999, excluding 01953 and 01996, and are reimbursed as time-base
Excela Health School of Anesthesia: DNAP, MHS University of South Florida: Simulation-Based Academic Fellowship in Advanced Pain Management Board Certified in Non- surgical pain management: NSPM -C Middle Tennessee School of Anesthesia: Acute Surgical Pain Management Fellowship WVANA Pain Management, Government Relations Chairs .
Understanding Anaesthesia Equip. Dorsch&Dorsch Williams and Wilkins Anesthesia Equipment: Principles and Application, 2nd edition,Ehrenwerth&Eisenkraft SOURCE TEXT BOOKS FOR THE MCQ’S IN ANESTHESIA General: Clinical Anesthesia,Barash latest edition Anesthesia, Miller, latest edition Pharmacology:
